Human papillomavirus and chlamydia trachomatis infections in rheumatoid arthritis under anti-TNF therapy: an observational study

Abstract

The objective of this study was to evaluate human papillomavirus (HPV) and Chlamydia trachomatis (CT) infections in RA patients pre- and post-TNF blocker. Fifty female RA patients (ACR criteria), who were eligible to anti-TNF therapy [n = 50 at baseline (BL) and n = 45 after 6 months of treatment (6 M)], and 50 age-matched healthy controls were prospectively enrolled. They were assessed for demographic data, gynecologic, sexual, cervical cytology and histological evaluations, disease parameters and current treatment. HPV DNA and CT DNA testing in cervical specimens were done using Hybrid Capture II assays. At BL, the median current age of RA patients and controls was 49 (18-74) versus 49 (18-74) years, p = 1.0. A trend of lower frequency of HPV infection was observed in AR patients pre-anti-TNF compared with controls (14 vs. 30%, p = 0.054). Further evaluation of AR patients with and without HPV infection before anti-TNF therapy showed that the former group had higher frequency of sexual intercourses (100 vs. 48%, p = 0.014), higher median number of sexual partners [1 (1-1) vs. 0 (0-1), p = 0.032] and higher frequency of abnormal cervical cytology (43 vs. 7%, p = 0.029). Current age, disease duration, disease parameters and treatments were alike in both groups (p > 0.05). At 6 M after TNF blockage, HPV infection remained unchanged in five patients, whereas two became negative and one additional patient turned out to be positive (p = 1.0). CT infection was uniformly negative in RA patients pre- and post-TNF blockage and in controls. Anti-TNF does not seem to increase short-term risk of exacerbation and/or progression of HPV and CT infections in RA patients.

Anogenital Human Papillomavirus Prevalence is Unaffected by Therapeutic Tumour Necrosis Factor-alpha Inhibition

“…In particular, IBD per se was reported to pose an independent risk factor for the development of cervical pathologies (9-11, 25, 26). In a recently published study, no elevated risk of mucosal HPV infection, represented by HPV DNA and cervical cytopathology, was observed in female patients with rheumatoid arthritis, prior to and at 6 months of anti-TNF-α treatment compared with healthy controls (13). In our study cohort, participants had received TNF-α agents continuously for at least 6 months, the mean treatment duration was 31.4 months, and the longest period encompassed 96 months of intervention.…”

“…In females with Crohn's disease, anti-TNF-α therapy was associated with a higher risk of cervical dysplasia compared with a healthy control population (12). Recently, female patients with rheumatoid arthritis were prospectively investigated for the presence of high-risk mucosal HPV infection, represented by HPV DNA and cervical cytopathology, prior to and at 6 months of anti-TNF-α treatment (13). After this relatively short period of TNF-α blockade, HPV infection remained unchanged in the majority of recipients and none developed visible lesions, suggesting that 6 months of therapy do not strongly influence the outcome of high-risk HPV infection and disease.…”

Lower genital tract infections in young female juvenile idiopathic arthritis patients

“…The presence of vaginal discharge and sexual function (age of first sexual intercourse, number of sexual activity in the last month, number of sexual activity in the last year, number of sexual partners in the last month and number of sexual partners in the last year) were registered based on recollection [6]. A systematic clinical examination of the genitalia was performed by the same expert gynecologist at study entry and includes evaluation of vulva, hymen, vagina and cervix [11].…”

“…The material of the Cytobrush® was rolled over the slide and the material on the spatula Ayre was spread on a thin layer in one movement over the middle third of the slide. After the fixation by immersion in 95% ethanol, the specimens were immediately transported to the laboratory [6]. All Pap smears were evaluated by the same cytopathologist blinded to gynecology examination in our University Hospital.…”

“…Others and we have previously demonstrated that lower genital tract infections, such as human papillomavirus (HPV) and Chlamydia trachomatis (CT) [5][6][7][8] are relevant issues in sexually active adults with rheumatoid arthritis (RA). There are, however, no studies assessing these infections and Neisseria gonorrhoeae (NG) in female adolescent and young adults with JIA.…”